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"Supportive relationships (and a decent place to live). Intense loneliness and social isolation are among the biggest problems for people with schizophrenia. The relationships Nash had with fellow mathematicians were essential to his eventual recovery, but the single most important factor in Nash's recovery was the bond with his remarkable wife, Alicia. . . . Most people who have recovered credit the steadfast encouragement of another person who they say believed in them: a therapist, teacher, counselor, nurse or, less often, a family member." -Boodman
If an individual needs to live in an environment where everything from wake-up time to meals to showering is structured for them, how do you prepare that person to live on their own? This is the question I was left with at the end of my last paper: how do successful rehabilitation and re-integration occur?
Every other Thursday a woman comes to Women of Change (WOC) to do 'life-skills' workshops where she and the women talk about healthy behaviors, good hygiene practices, easy home remedies, and the like. This is part of the process that occurs at the center, of trying to equip the women with the tools they'll need to live on there own. I had been questioning the effectiveness of these sessions for a while without really knowing why. Last Thursday I began to figure it out.
The woman brought in a sheet with two columns on it: one, a list of minor sicknesses and injuries, the other, a list of easy ways to deal with them. There is a woman at the center, Tara, whom I think to be in her late forty's. She doesn't talk or interact much with the other residents. A lot of the time you'll see her standing by herself with a blank look on her face, like she just got stopped on her way to somewhere and forgot that she was going anywhere at all. During this activity, I saw her sitting with a pen in her hand in front of her worksheet rocking back and forth and not focusing on the paper at all - so I went over to help her. I didn't know if she just couldn't concentrate on the paper, or if she couldn't read very well, or if she didn't know the answers and it was too hard for her, but I figured if it was a problem of focus and making it clear then I could help. I started by reading her the first malady, and then reading down the list of cures before repeating the malady and asking her which one she would pick. At first she didn't answer, so I asked her if she understood what the injury was and she said yes. So I repeated the cures again one by one and when I came to the matching one she stopped me and said that was it. I had to keep talking her through it to get her to draw the line from match to match and for each one we had to go through the same process. But the thing was that this woman, who for the first couple of weeks of my volunteer work I didn't even think could talk, this woman knew all of the illnesses and all of their cures right down to something like baking soda for a bee sting and eating fiber for constipation.
This knowledge wasn't new to her - she'd already learned it somewhere along the road. How was this drill then equipping her for anything when, although she knew the answers, she needed help just to concentrate on the assignment? Can you give a woman like this enough tools for her to live on her own? In an environment where most everything is done and provided for her including regular medication, she still had not achieved a level of functioning that would allow for regular social interaction. How do you make this woman ready to succeed in the every-day world?
"what helped me recover was not drugs; which were one tool I used; it was people. I had a psychiatrist who always believed in me, and family and friends who stood by me. Changing my career and following my dream; becoming a doctor; was very important." - Boodman
Well, I found out that you don't. According to the director at the center, the ones who are most likely to succeed - that is, not end up back in a shelter or on the streets - are the ones that have a good support system outside the center, much like they had inside. If there's someone to make sure they remember to take their meds, someone to check up on them, someone to ensure that their housing problems are being met, someone to make sure that they go in to work every day, then they really have a chance of making it. But without that, these women typically do not have what they need to take care of themselves. They go back out on the streets and perhaps start taking drugs again (many of the women I've talked to have told me about their past drug habits) or else they seek out another shelter where they can be modestly taken care of.
"For others, mental illness is complicated by other serious problems: substance abuse, homelessness, poverty and an increasingly dysfunctional mental health system that favors 10-minute monthly medication checks, which are covered by insurance, over more effective but time-consuming forms of support, which are not." -Boodman
I guess after you have a lot of practice living in on your own that you get better at it and perhaps as time goes by, you don't need all of the extra help getting along. But the long and the short of it seems to be that there is not presently a way to make these women self-sufficient. You can teach them all the life-skills you want - most of them already know many - but unless someone is there to make sure they are able to employ these skills it doesn't seem to me to do much good.
This is where I think a social understanding of mental illness becomes really important. How can these women, many of whom do not have families, build a social support network in a society that doesn't understand how they function and what their needs are? Then we must also consider the contents of the Surgeon General's reports, which state that:
"the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age and gender," and, "People who are homeless, incarcerated and institutionalized all have higher rates of mental disorders, and minorities are over-represented in these groups." -"Culture Counts" article in Notes for class #8
The WOC population is about 65% black - these women have schizophrenia - this is a homeless shelter - this is where so many of the people that don't receive equal treatment end up! There has to be more social and cultural awareness of these people if they are to successfully re-enter society, because they're going to need help doing it - especially if they haven't been privy to the psychological and psychiatric support they should be entitled to.
Which leaves me with the question of who should be responsible for the health of these people? I was going to say that if our government isn't giving them the treatment they need, then we as people should be responsible for helping them to enter mainstream society. After all, it is society that has made the rules one has to follow in order not to be excluded from it; if there is a way to include these women and other mentally ill individuals we should be made to be able to accommodate them. But wouldn't it help things considerably if sick individuals got the best treatment possible from mental health experts so that when they were ready to re-enter society they were as functional as possible? One can only conclude that everybody should help out - but how do you get everybody to do anything? What solutions can we possibly devise?
Boodman, Sandra G. "A 'Beautiful' - but Not Rare - Recovery." Washington Post in Supplimental Readings for Praxis: Mental Health: a Bio. Psycho. Social Perspective
Boodman, Sandra G. "Some Factors that May Support Recovery." Washington Post in Supplimental Readings for Praxis: Mental Health: a Bio. Psycho. Social Perspective
Culture Counts in MH Treatment, Says Surgeon General's Report. Mental Health Weekly 11(33):1-2, 2001. copyright 2001 Manisses Comunications Group, Inc.
